Even before he is sworn in as a Senator, iconoclastic Oklahoma Republican Tom Coburn is making waves, expressing a desire to continue practicing medicine after taking office — an activity that would be prohibited under longstanding Senate restrictions.

In the meantime, Coburn is also facing questions from the Federal Election Commission about the finances of his Senatorial campaign. In late November, the FEC warned Coburn’s campaign committee that he may have accepted tens of thousands of dollars in excess or prohibited contributions during his race against Democrat Brad Carson.

On the issue of Coburn’s medical practice, the incoming Senator is already receiving negative feedback from staff of the Senate Ethics Committee, but Coburn will continue to press the matter, said John Hart, Coburn’s spokesman.

“We have received some unsolicited, unofficial opinions from [Ethics Committee] staff that do not have any bearing on the issue until he is a member of the Senate,” Hart said. Neither the Senate nor the executive branch allows elected or appointed officials, or employees of any kind, to practice medicine on private patients.

Hart said Coburn will make a concerted push for either a change in Senate rules or a waiver from current ethics restrictions after he is sworn in on Jan. 4.

Some Senate Democrats oppose Coburn’s waiver request, seeing it as a bid by Coburn for preferential treatment and endemic of larger GOP aspirations to bend the rules to their own liking.

“Time and time again, Republicans are asking for a different set of rules for themselves,” said a senior Senate Democratic aide familiar with Coburn’s request. “This flies in the face of the traditions of the Senate.”

Coburn’s annual income from his medical practice was far more than the $158,100 he will make as a Senator next year. He also served in the House from 1995 to 2000.

During 2003, Coburn earned slightly more than $380,000 from his medical practice, according to the financial disclosure form he filed as a Senate candidate. Coburn pocketed an additional $25,000 from other sources in that same period. Coburn’s net worth is between $1 million and $3 million.

Thomas A. Coburn Inc., of which Coburn is president, provided Coburn with a salary and “business income” of more than $190,000, while the Muskogee Allergy Clinic paid Coburn $121,500 in salary, and another $67,339 in “business income.” Coburn is a managing partner of the clinic.

Coburn, a family practitioner who specializes in obstetrics, is listed as the manager of Maternal & Family Practice Associates of Muskogee, Okla., and is a managing partner in two real-estate partnerships, one of which is apparently tied to his medical practice. Coburn also serves as the president of a residential construction company and a golf course. He is a director for a publishing firm and for the Family Research Council, a prominent conservative organization.

Under Senate rules, Coburn would be prohibited from practicing medicine, even on a part-time basis as he did while serving in the House. Coburn delivered “close to 400 babies” during his time in the House, Hart said.

According to the Senate Ethics Manual, Senators “may not receive compensation for providing professional services involving a fiduciary relationship, or for being employed by an organization that provides such services.”

In addition, Senators “may not affiliate with outside persons or entities for the purpose of providing professional services” for which they are paid, and “may not allow their names to be used by organizations providing professional services for compensation.”

Senators and senior staffers are permitted to receive an additional 15 percent on top of their salary in “outside earned income,” although there are tight restrictions on what they can do to earn that money.

While in the House, Coburn faced similar objections to continuing his medical career. Coburn and several other Members who were doctors eventually forced the House ethics committee to compromise with their request to be allowed to practice medicine, arguing that the demands of their specialty are unique and different from those facing lawyers or other professionals elected to Congress.

In February 1998, following an inquiry from Rep. Vic Snyder (D-Ark.), the House ethics committee declared that the ban on Members providing professional services for compensation also applied to medicine, reversing an earlier position.

In a Feb. 23, 1998, memo, the House ethics committee ruled that it “will no longer approve the receipt of compensation for any professional services that involve a ‘fiduciary relationship’ as that term is generally defined in law. The prohibition … extends to the practice of medicine for compensation.”

Coburn bitterly objected to the ethics committee’s decision, and the Oklahoma Republican at one point threatened to retire from Congress unless the ruling was overturned.

After a personal appeal to the ethics committee by Coburn and other lawmakers, the panel, chaired by then-Rep. James Hansen (R-Utah), allowed the physicians to earn enough to cover expenses such as malpractice insurance and medical licenses. Coburn was also allowed to continue writing prescriptions.

But the House ethics committee struggled with a range of questions related to the controversy, such as whether a Member could keep their name on a clinic door or an insurance form.

Hart said Coburn’s request is not motivated by money but rather a commitment to his patients’ health. As a doctor, Coburn has “an ethical responsibility” to continuing treating those men and women currently under his care, “including some with high-risk pregnancies,” said Hart.

Hart also noted that to remain an effective doctor, Coburn must keep current with the latest advances in medical technologies and techniques.

In addition, Hart argued that his patients are not using Coburn’s medical services in a bid to sway government policy, which was the intent of the conflict-of-interest rules for lawmakers. “Doctors are unique on the conflict-of-interest dynamic,” Hart said.

Finally, Hart said Coburn’s philosophical identification as a “citizen-legislator” makes it logical that he would want to continue being active as a doctor, despite his election to the Senate.

Coburn’s position contrasts with that of Senate Majority Leader Bill Frist (R-Tenn.), an acclaimed transplant surgeon before entering politics. Frist continues to perform some surgeries on a charitable basis when not engaged in Senate business. Frist also covers the costs of his malpractice insurance out of his own pocket.

In the meantime, the FEC has brought to light a number of potentially serious problems with Coburn’s campaign paperwork, according to recent warning letters from the agency.

A Nov. 23 letter from FEC Senior Campaign Finance Analyst Leah Palmer to Coburn campaign treasurer Wade Stubbs listed several potential violations of federal campaign finance regulations, ranging from inadequate disclosure of donations to what appeared to be excessively large contributions from several donors, including Frist’s Volunteer PAC, which gave Coburn campaign two contributions totaling $10,000 on Sept. 21.

Multi-candidate PACs like the Volunteer PAC are limited to giving $5,000 per election.

Meanwhile, some other excessive contributions appeared to be “in the form of an advance from a committee staff member of other individual,” the 11-page letter explained.

Coburn’s campaign finance reports covering most of July, August and September detail numerous instances in which campaign staffers seemed to be fronting the money for campaign expenses and were later reimbursed, a practice that is strictly governed by the FEC and that requires exact reporting, which Coburn’s campaign may not have followed.

Campaign finance experts interviewed by Roll Call said it is particularly unusual to see these sorts of staff advances in a Senate campaign and said they are more common in House races.

Among the other problems spotted by Palmer were discrepancies in Coburn’s aggregate election cycle-to-date contribution totals. She noted that in at least two-dozen instances, the committee had failed to file 48-hour reports detailing last-minute contributions

Coburn’s campaign committee also failed to disclose full or recognizable names of political committees from which he had received contributions, Palmer observed.

“Reporting only the name of the connected organization, abbreviating the name of the committee so it is unrecognizable or using an indistinguishable acronym is inadequate,” Palmer said.

In a separate letter, also dated Nov. 23, Palmer detailed a number of similar questions with Coburn’s 12-day pre-general election report.

Both FEC letters requested a response from the Coburn campaign by Dec. 23 and noted that “any response submitted” would be placed on the public record and “considered by the Commission prior to taking enforcement action.”

Hart acknowledged that Coburn’s office had received the letters from the FEC and was moving to address the agency’s concerns, adding that the campaign “will take whatever steps are necessary to be fully in compliance with the law.”